Outpatient Facility Coding Alert - 2016 Issue 6
Reader Question: Learn Split/Shared Visit Rules to Avoid Pay Cuts
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Article Overview
This reader Q&A covers the general framework for split/shared evaluation and management visits in the Medicare setting. It is intended for clinicians, NPs, physicians, and coding/billing staff who need to understand when split/shared reporting is discussed, what broad documentation considerations apply, and why the topic affects payment. The article also touches on the distinction between E/M services and procedure codes and highlights that billing approaches can affect reimbursement levels.
Why This Topic Matters
Split/shared visit reporting can materially affect how a service is billed and how much the practice is paid. Understanding the topic helps coding and clinical staff recognize the general requirements discussed in the article and determine whether the full guidance is relevant to their workflow.
Article Sections
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Question
Introduces the reader’s question about split/shared visits in the Medicare context and how billing is handled.
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Answer
Provides a general overview of split/shared visits involving more than one provider and discusses the broad relationship to E/M services.
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Benefit
Summarizes the payment impact discussed in the article and the role of billing under different provider identifiers.
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Example
Presents a hospital-based encounter example used to illustrate the split/shared visit concept.
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Caveat
Notes a documentation-related limitation discussed in the article for reporting under the physician’s identifier.
What You Will Learn
- The general concept of split/shared evaluation and management visits
- How split/shared visits are discussed in a Medicare billing context
- Why provider documentation and face-to-face involvement matter
- How the topic affects reimbursement at a high level
- The distinction between E/M services and procedure codes in this context
Who Should Read This
- Physicians
- Nurse practitioners
- Nonphysician practitioners
- Medical coders
- Medical billers
- Practice administrators
Codes Discussed
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